|
TIGER CANNULATED SCREW 4.0MM X 40MM
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8773161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$98.96 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$99.93
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$98.96
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$100.48
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$100.43
|
| Rate for Payer: Oscar Health of IA Commercial |
$148.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
|
|
TIGER CANNULATED SCREW 4.0MMX52MM
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8758424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
TIGER CANNULATED SCREW 4.0MMX52MM
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8758424
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$98.96 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$99.93
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$98.96
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$100.48
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$100.43
|
| Rate for Payer: Oscar Health of IA Commercial |
$148.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
|
|
TIGER CANNULATED SCREW 4.0MMX54MM
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8758426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$98.96 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$99.93
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$98.96
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$100.48
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$100.43
|
| Rate for Payer: Oscar Health of IA Commercial |
$148.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
|
|
TIGER CANNULATED SCREW 4.0MMX54MM
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8758426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
TIGER CANULATED SCREW 4.0MMX42MM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8810196
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.60 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna of IA Commercial |
$160.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$160.20
|
| Rate for Payer: Cash Price |
$142.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$133.50
|
| Rate for Payer: Medical Associates Commercial |
$133.50
|
| Rate for Payer: Midlands Choice Commercial |
$124.60
|
| Rate for Payer: United Healthcare Commercial |
$160.20
|
|
|
TIGER CANULATED SCREW 4.0MMX42MM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8810196
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.96 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna of IA Commercial |
$160.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$160.20
|
| Rate for Payer: Aetna of IA Medicare |
$101.46
|
| Rate for Payer: Amerigroup Medicaid |
$89.84
|
| Rate for Payer: Amerigroup Medicare |
$89.89
|
| Rate for Payer: Cash Price |
$142.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$133.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$89.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$88.96
|
| Rate for Payer: Medical Associates Commercial |
$133.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$89.00
|
| Rate for Payer: Midlands Choice Commercial |
$124.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$90.34
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$90.28
|
| Rate for Payer: Oscar Health of IA Commercial |
$133.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$133.50
|
| Rate for Payer: United Healthcare Commercial |
$160.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$105.02
|
|
|
TIGERTAPE
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047072
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$340.20 |
| Max. Negotiated Rate |
$437.40 |
| Rate for Payer: Aetna of IA Commercial |
$437.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$437.40
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$364.50
|
| Rate for Payer: Medical Associates Commercial |
$364.50
|
| Rate for Payer: Midlands Choice Commercial |
$340.20
|
| Rate for Payer: United Healthcare Commercial |
$437.40
|
|
|
TIGERTAPE
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047072
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.90 |
| Max. Negotiated Rate |
$437.40 |
| Rate for Payer: Aetna of IA Commercial |
$437.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$437.40
|
| Rate for Payer: Aetna of IA Medicare |
$277.02
|
| Rate for Payer: Amerigroup Medicaid |
$245.28
|
| Rate for Payer: Amerigroup Medicare |
$245.43
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$364.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$243.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$242.90
|
| Rate for Payer: Medical Associates Commercial |
$364.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$243.00
|
| Rate for Payer: Midlands Choice Commercial |
$340.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$246.64
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$246.50
|
| Rate for Payer: Oscar Health of IA Commercial |
$364.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$364.50
|
| Rate for Payer: United Healthcare Commercial |
$437.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$286.74
|
|
|
tildrakizumab-asmn 100 mg/mL Syringe PFS [VDMC]
|
Facility
|
IP
|
$34,574.94
|
|
|
Service Code
|
HCPCS J3245
|
| Hospital Charge Code |
24914770
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$24,202.46 |
| Max. Negotiated Rate |
$31,117.45 |
| Rate for Payer: Aetna of IA Commercial |
$31,117.45
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$31,117.45
|
| Rate for Payer: Cash Price |
$27,659.95
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$25,931.20
|
| Rate for Payer: Medical Associates Commercial |
$25,931.20
|
| Rate for Payer: Midlands Choice Commercial |
$24,202.46
|
| Rate for Payer: United Healthcare Commercial |
$31,117.45
|
|
|
tildrakizumab-asmn 100 mg/mL Syringe PFS [VDMC]
|
Facility
|
OP
|
$34,574.94
|
|
|
Service Code
|
HCPCS J3245
|
| Hospital Charge Code |
24914770
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17,280.56 |
| Max. Negotiated Rate |
$31,117.45 |
| Rate for Payer: Aetna of IA Commercial |
$31,117.45
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$31,117.45
|
| Rate for Payer: Aetna of IA Medicare |
$19,707.72
|
| Rate for Payer: Amerigroup Medicaid |
$17,449.97
|
| Rate for Payer: Amerigroup Medicare |
$17,460.34
|
| Rate for Payer: Cash Price |
$27,659.95
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$25,931.20
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$17,287.47
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$17,280.56
|
| Rate for Payer: Medical Associates Commercial |
$25,931.20
|
| Rate for Payer: Medical Associates Managed Medicare |
$17,287.47
|
| Rate for Payer: Midlands Choice Commercial |
$24,202.46
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$17,546.78
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$17,536.41
|
| Rate for Payer: Oscar Health of IA Commercial |
$25,931.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$25,931.20
|
| Rate for Payer: United Healthcare Commercial |
$31,117.45
|
| Rate for Payer: United Healthcare Managed Medicare |
$20,399.21
|
|
|
Timolol Maleate Ophth 0.5% 5 ml Sol [VDMC]
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10439520
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
|
|
Timolol Maleate Ophth 0.5% 5 ml Sol [VDMC]
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10439520
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$15.99 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Aetna of IA Commercial |
$28.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.80
|
| Rate for Payer: Aetna of IA Medicare |
$18.24
|
| Rate for Payer: Amerigroup Medicaid |
$16.15
|
| Rate for Payer: Amerigroup Medicare |
$16.16
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.99
|
| Rate for Payer: Medical Associates Commercial |
$24.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.00
|
| Rate for Payer: Midlands Choice Commercial |
$22.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.24
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$16.23
|
| Rate for Payer: Oscar Health of IA Commercial |
$24.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.00
|
| Rate for Payer: United Healthcare Commercial |
$28.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.88
|
|
|
timolol Ophth 0.25% 5ml Sol [VDMC]
|
Facility
|
OP
|
$30.88
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10439455
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$15.43 |
| Max. Negotiated Rate |
$27.79 |
| Rate for Payer: Aetna of IA Commercial |
$27.79
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$27.79
|
| Rate for Payer: Aetna of IA Medicare |
$17.60
|
| Rate for Payer: Amerigroup Medicaid |
$15.59
|
| Rate for Payer: Amerigroup Medicare |
$15.59
|
| Rate for Payer: Cash Price |
$24.70
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$23.16
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$15.44
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.43
|
| Rate for Payer: Medical Associates Commercial |
$23.16
|
| Rate for Payer: Medical Associates Managed Medicare |
$15.44
|
| Rate for Payer: Midlands Choice Commercial |
$21.62
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15.67
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$15.66
|
| Rate for Payer: Oscar Health of IA Commercial |
$23.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$23.16
|
| Rate for Payer: United Healthcare Commercial |
$27.79
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.22
|
|
|
timolol Ophth 0.25% 5ml Sol [VDMC]
|
Facility
|
IP
|
$30.88
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10439455
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$21.62 |
| Max. Negotiated Rate |
$27.79 |
| Rate for Payer: Aetna of IA Commercial |
$27.79
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$27.79
|
| Rate for Payer: Cash Price |
$24.70
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$23.16
|
| Rate for Payer: Medical Associates Commercial |
$23.16
|
| Rate for Payer: Midlands Choice Commercial |
$21.62
|
| Rate for Payer: United Healthcare Commercial |
$27.79
|
|
|
timolol ophthalmic maleate 0.5% Sol 2.5ml [VDMC]
|
Facility
|
OP
|
$295.32
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
20409234
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$147.60 |
| Max. Negotiated Rate |
$265.79 |
| Rate for Payer: Aetna of IA Commercial |
$265.79
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$265.79
|
| Rate for Payer: Aetna of IA Medicare |
$168.33
|
| Rate for Payer: Amerigroup Medicaid |
$149.05
|
| Rate for Payer: Amerigroup Medicare |
$149.14
|
| Rate for Payer: Cash Price |
$236.26
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$221.49
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$147.66
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$147.60
|
| Rate for Payer: Medical Associates Commercial |
$221.49
|
| Rate for Payer: Medical Associates Managed Medicare |
$147.66
|
| Rate for Payer: Midlands Choice Commercial |
$206.72
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$149.87
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$149.79
|
| Rate for Payer: Oscar Health of IA Commercial |
$221.49
|
| Rate for Payer: Partners Health Alliance Commercial |
$221.49
|
| Rate for Payer: United Healthcare Commercial |
$265.79
|
| Rate for Payer: United Healthcare Managed Medicare |
$174.24
|
|
|
timolol ophthalmic maleate 0.5% Sol 2.5ml [VDMC]
|
Facility
|
IP
|
$295.32
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
20409234
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$206.72 |
| Max. Negotiated Rate |
$265.79 |
| Rate for Payer: Aetna of IA Commercial |
$265.79
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$265.79
|
| Rate for Payer: Cash Price |
$236.26
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$221.49
|
| Rate for Payer: Medical Associates Commercial |
$221.49
|
| Rate for Payer: Midlands Choice Commercial |
$206.72
|
| Rate for Payer: United Healthcare Commercial |
$265.79
|
|
|
tiotropium 18 mcg Inh Cap [VDMC]
|
Facility
|
IP
|
$199.52
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10425225
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$139.66 |
| Max. Negotiated Rate |
$179.57 |
| Rate for Payer: Aetna of IA Commercial |
$179.57
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$179.57
|
| Rate for Payer: Cash Price |
$159.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$149.64
|
| Rate for Payer: Medical Associates Commercial |
$149.64
|
| Rate for Payer: Midlands Choice Commercial |
$139.66
|
| Rate for Payer: United Healthcare Commercial |
$179.57
|
|
|
tiotropium 18 mcg Inh Cap [VDMC]
|
Facility
|
OP
|
$199.52
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10425225
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$99.72 |
| Max. Negotiated Rate |
$179.57 |
| Rate for Payer: Aetna of IA Commercial |
$179.57
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$179.57
|
| Rate for Payer: Aetna of IA Medicare |
$113.73
|
| Rate for Payer: Amerigroup Medicaid |
$100.70
|
| Rate for Payer: Amerigroup Medicare |
$100.76
|
| Rate for Payer: Cash Price |
$159.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$149.64
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.76
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$99.72
|
| Rate for Payer: Medical Associates Commercial |
$149.64
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.76
|
| Rate for Payer: Midlands Choice Commercial |
$139.66
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$101.26
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$101.20
|
| Rate for Payer: Oscar Health of IA Commercial |
$149.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$149.64
|
| Rate for Payer: United Healthcare Commercial |
$179.57
|
| Rate for Payer: United Healthcare Managed Medicare |
$117.72
|
|
|
tirofiban 50 mcg/mL 250ml SD Sol [VDMC]
|
Facility
|
IP
|
$921.76
|
|
|
Service Code
|
HCPCS J3246
|
| Hospital Charge Code |
11224748
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$645.23 |
| Max. Negotiated Rate |
$829.58 |
| Rate for Payer: Aetna of IA Commercial |
$829.58
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$829.58
|
| Rate for Payer: Cash Price |
$737.41
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$691.32
|
| Rate for Payer: Medical Associates Commercial |
$691.32
|
| Rate for Payer: Midlands Choice Commercial |
$645.23
|
| Rate for Payer: United Healthcare Commercial |
$829.58
|
|
|
tirofiban 50 mcg/mL 250ml SD Sol [VDMC]
|
Facility
|
OP
|
$921.76
|
|
|
Service Code
|
HCPCS J3246
|
| Hospital Charge Code |
11224748
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$460.70 |
| Max. Negotiated Rate |
$829.58 |
| Rate for Payer: Aetna of IA Commercial |
$829.58
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$829.58
|
| Rate for Payer: Aetna of IA Medicare |
$525.40
|
| Rate for Payer: Amerigroup Medicaid |
$465.21
|
| Rate for Payer: Amerigroup Medicare |
$465.49
|
| Rate for Payer: Cash Price |
$737.41
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$691.32
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$460.88
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$460.70
|
| Rate for Payer: Medical Associates Commercial |
$691.32
|
| Rate for Payer: Medical Associates Managed Medicare |
$460.88
|
| Rate for Payer: Midlands Choice Commercial |
$645.23
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$467.79
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$467.52
|
| Rate for Payer: Oscar Health of IA Commercial |
$691.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$691.32
|
| Rate for Payer: United Healthcare Commercial |
$829.58
|
| Rate for Payer: United Healthcare Managed Medicare |
$543.84
|
|
|
Tissue Transglutaminase IgA Ab DMCL
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
8037815
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna of IA Commercial |
$99.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$99.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$82.50
|
| Rate for Payer: Medical Associates Commercial |
$82.50
|
| Rate for Payer: Midlands Choice Commercial |
$77.00
|
| Rate for Payer: United Healthcare Commercial |
$99.00
|
|
|
Tissue Transglutaminase IgA Ab DMCL
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
8037815
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna of IA Commercial |
$99.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$99.00
|
| Rate for Payer: Aetna of IA Medicare |
$62.70
|
| Rate for Payer: Amerigroup Medicaid |
$55.52
|
| Rate for Payer: Amerigroup Medicare |
$55.55
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$82.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$55.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$54.98
|
| Rate for Payer: Medical Associates Commercial |
$82.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$55.00
|
| Rate for Payer: Midlands Choice Commercial |
$77.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$55.82
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$55.79
|
| Rate for Payer: Oscar Health of IA Commercial |
$82.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$82.50
|
| Rate for Payer: United Healthcare Commercial |
$99.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$64.90
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Tissue Transglutaminase IgG Ab DMCL
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
8037816
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna of IA Commercial |
$99.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$99.00
|
| Rate for Payer: Aetna of IA Medicare |
$62.70
|
| Rate for Payer: Amerigroup Medicaid |
$55.52
|
| Rate for Payer: Amerigroup Medicare |
$55.55
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$82.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$55.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$54.98
|
| Rate for Payer: Medical Associates Commercial |
$82.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$55.00
|
| Rate for Payer: Midlands Choice Commercial |
$77.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$55.82
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$55.79
|
| Rate for Payer: Oscar Health of IA Commercial |
$82.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$82.50
|
| Rate for Payer: United Healthcare Commercial |
$99.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$64.90
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Tissue Transglutaminase IgG Ab DMCL
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
8037816
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna of IA Commercial |
$99.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$99.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$82.50
|
| Rate for Payer: Medical Associates Commercial |
$82.50
|
| Rate for Payer: Midlands Choice Commercial |
$77.00
|
| Rate for Payer: United Healthcare Commercial |
$99.00
|
|
